Central Retinal Vein Occlusion Associated with Herpes Zoster Ophthalmicus: A Case Report

Purpose: Central retinal vein occlusion (CRVO) as an initial manifestation of herpes zoster ophthalmicus (HZO) is exceptionally rare.This case report describes an unusual presentation of varicella-zoster virus (VZV)-induced CRVO in an immunocompetent patient and emphasizes the importance of maintaining clinical suspicion for VZV vasculitis in patients presenting with CRVO.Case summary: A 64-year-old immunocompetent man presented with right ocular pain and headache for three days.Initial ophthalmologic evaluation revealed multiple retinal hemorrhages distributed throughout all quadrants with delayed arteriovenous transit time on fluorescein angiography, leading to a diagnosis of idiopathic CRVO.The following day, characteristic vesicular eruptions appeared over the ophthalmic division of the trigeminal nerve on the right side of the face, prompting clinical suspicion of HZO.Serologic testing for syphilis and human immunodeficiency virus was negative.The patient was treated with intravenous acyclovir (500 mg three times daily) for seven days, along with topical ganciclovir and levofloxacin.At one-year follow-up, best-corrected visual acuity remained 20/20 with complete resolution of the retinal hemorrhages.Retinal pigment epithelium changes representing chronic sequelae of the resolved VZV retinal vasculitis were noted.Conclusions: VZV-associated CRVO can present as a limited, reversible manifestation of retinal vasculitis with favorable visual outcomes when antiviral therapy is initiated promptly.High clinical suspicion for VZV vasculitis should be maintained in CRVO patients who have signs of ocular inflammation because early diagnosis and treatment are critical for optimal clinical outcomes.